Useful to visualize the biliary tree and to assess liver and gallbladder function can diagnose or rule out biliary dyskinesia High sensitivity (97%) and specificity (77%) for the diagnosis of acute cholecystitis normal findings virtually rule out acute cholecystitis Inexpensive noninvasive first-line test for patients with suspected gallstones or acute cholecystitis provides anatomic information, such as presence of polyps, common bile duct diameter, and parenchymal hepatic abnormalities High specificity (> 98%) and sensitivity (> 95%) for identifying gallstones false-negative rate of 1% to 4% Percutaneous cholecystostomy is an alternative for patients who are critically ill with gallbladder empyema and sepsis. Laparoscopic cholecystectomy remains the surgical choice for symptomatic and complicated gallstones, with a shorter hospital stay and shorter convalescence period than open cholecystectomy. Oral dissolution therapy is usually minimally successful and used only if the patient cannot undergo surgery. The management of acute biliary colic mainly involves pain control with nonsteroidal anti-inflammatory drugs or narcotic pain relievers. Ultrasonography is the best initial imaging study for most patients, although additional imaging studies may be indicated.
If pain persists with the onset of fever or high white blood cell count, it should raise suspicion for complications such as acute cholecystitis, gallstone pancreatitis, and ascending cholangitis. The pain is characteristically steady, is usually moderate to severe in intensity, is located in the epigastrium or right upper quadrant of the abdomen, lasts one to five hours, and gradually subsides. Once symptoms appear, the usual presentation of uncomplicated gallstones is biliary colic, caused by the intermittent obstruction of the cystic duct by a stone. Asymptomatic patients have a low annual rate of developing symptoms (about 2% per year). Most patients are asymptomatic gallstones are discovered incidentally during ultrasonography or other imaging of the abdomen. At-risk populations include persons with diabetes mellitus, persons who are obese, women, rapid weight cyclers, and patients on hormone therapy or taking oral contraceptives. The incidence of gallstones increases with age.
Cholelithiasis, or gallstones, is one of the most common and costly of all the gastrointestinal diseases.
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